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Role of non-high-density lipoprotein cholesterol in predicting cerebrovascular events in patients following myocardial infarction
The American Journal of Cardiology, 06/01/2012
Mahajan N et al. – Non–high–density lipoprotein (HDL) cholesterol is the strongest predictor among the lipid risk factors of incident cerebrovascular disease (CVD) in patients with established coronary heart disease.
Methods- The CARE trial was a placebo–controlled trial aimed at testing the effect of pravastatin on patients after myocardial infarction.
- Patients with histories of CVD were excluded from the study.
- A Cox proportional–hazards model was used to evaluate the association between plausible risk factors (including lipid fractions) and risk for first incident CVD in patients after myocardial infarction.
- At the end of 5 years, 123 patients (6%) had incident CVD after myocardial infarction (76 with stroke and 47 with transient ischemic attack).
- Baseline non–high–density lipoprotein (HDL) cholesterol level emerged as the only significant lipid risk factor that predicted CVD; low–density lipoprotein cholesterol and HDL cholesterol were not significant.
- The adjusted hazard ratios (adjusted for age, gender, hypertension, diabetes mellitus, and smoking) for CVD were 1.28 (95% confidence interval [CI] 1.06 to 1.53) for non–HDL cholesterol, 1.14 (95% CI 0.96 to 1.37) for low–density lipoprotein cholesterol, and 0.90 (95% CI 0.75 to 1.09) for HDL cholesterol (per unit SD change of lipid fractions).
- This relation held true regardless of the level of triglycerides.
- After adjustment for age and gender, the hazard ratio for the highest natural quartile of non–HDL was 1.76 (95% CI 1.05 to 2.54), compared to 1.36 (95% CI 0.89 to 1.90) for low–density lipoprotein cholesterol.